Abstract YO33
Case summary
Background
Hyponatremia is known to be a modifiable prognostic factor in advanced cancer. It is also known to be a medical emergency. Correction of hyponatremia in the absence of urinary analysis and radiological investigations is a challenge. This case report discusses the feasibility and challenges involved in correction of hyponatremia in the Palliative medicine ward.
Case details
62 year old male patient with a smoking index of 2000, a known case of Adenocarcinoma of the lung with adrenal, liver and brain metastasis presented with backache, weakness and obstructive urinary symptoms. A biopsy done from the site of a pelvic fracture that he had obtained in the recent past was suggestive of a poorly differentiated tumor. A biopsy from the right lung mass was reported as adenocarcinoma. He was bieng evaluated for potentially reversible causes of deterioration in general medical condition during which routine biochemical and haematological investigations were sent. The successive serum sodium levels were found to be 100, less than 100, 82.8, 111 and 114.8 meq /l during the course of the next 12 hours. Fluid restriction was initiated after a presumptive diagnosis of Syndrome of Inappropriate ADH secretion had been considered. The 24 hour urine output was 2250 ml.
Discussion
The following questions with regards to the management of hyponatremia in advanced cancer merit further discussion – Is the palliative medicine ward a feasible setting for the management of an oncological emergency, can the diagnosis of SIADH be made presumptively in the absence of urine analysis, does the syndrome of cerebral salt wasting exist as a separate entity and are vaptans useful in the management of hyponatremia.
Laboratory parameters | 0 hours | +6 hours | +12 hours |
Serum Haemoglobin | 9.7 | 10.6 | |
Total Leucocyte count | 18800 | 21680 | |
Total Platelet count | 64000 | 85000 | |
ESR | 70 | ||
pH | 7.46 | 7.42 | 7.46 |
pCO2 | 26 | 30 | 25 |
pO2 | 41 | 49 | 68 |
Sodium | 100 | <100 | 82.8 |
Potassium | 4.9 | 4.4 | 5.7 |
Calcium | 0.40 | 0.59 | 0.92 |
Glucose | 101 | 203 | 195 |
Lactate | 1.4 | 1.6 | |
Bicarbonate | 18.5 | 26.4 | |
Total Co2 | 19.3 | 20.4 | |
Base equivalents | 5.3 | 4.1 | |
SpO2 | 80 | 82 |
Clinical trial identification
Editorial acknowledgement
Resources from the same session
YO9 - Small Malignant Phyllodes Tumor of the Breast with Metastases to the Lung and Bone
Presenter: Gusti Harti
Session: Poster display session
Resources:
Abstract
YO10 - Rectal Follicular Dendritic Cell Sarcoma
Presenter: Kripa Bajaj
Session: Poster display session
Resources:
Abstract
YO11 - Postoperative metastasis prediction based on portal vein circulating tumor cells detected by flow cytometry in periampullary or pancreatic cancer
Presenter: Lianyuan Tao
Session: Poster display session
Resources:
Abstract
YO12 - Case report of Hepatic EBV-associated smooth muscle tumor in AIDS patient
Presenter: Gorawich Kerkarchachai
Session: Poster display session
Resources:
Abstract
YO13 - IgG4-related pseudo-tumor of the kidney and multiple organ involvement mimicked malignancy
Presenter: Wasamol Mahaparn
Session: Poster display session
Resources:
Abstract
YO14 - Urachal Adenocarcinoma: Case Report
Presenter: Michelle Joane Alcantara
Session: Poster display session
Resources:
Abstract
YO15 - Concurrent Atezolizumab-Radiotherapy in Locally Recurrent Urinary Bladder Carcinoma: A Case Report
Presenter: Ma. Angelle Lalaine Dantes
Session: Poster display session
Resources:
Abstract
YO16 - Clear cell RCC with synchronous metastasis at transplanted kidney and bone in patient post Cadaveric donor kidney transplantation
Presenter: Punyaporn Cheewasathianchai
Session: Poster display session
Resources:
Abstract
YO17 - Serous ovarian cancer treated with palbociclib and letrozole
Presenter: Dai Wee Lee
Session: Poster display session
Resources:
Abstract
YO18 - A patient with Peutz-Jegher syndrome who incidentally found sex cord stromal tumor: a case report
Presenter: Pongput Pimsa
Session: Poster display session
Resources:
Abstract